June 11, 2012

In Doctor Patient Medical Associations recent national survey of physicians, 57% gave the American Medical Association (AMA) the failing "F" grade.  It's projected that AMA membership represents only 12-15% of practicing physicians throughout the United States.  While the AMA did not "totally reject the concept of an advisory board" 80% of physicians said IPAB will cut reimbursement rates to providers - which will harm beneficiary access, in a March poll conducted on Sermo.com.  Learn more about IPAB here.

Internal Emails: AMA, While Disliking IPAB Framework, Did Not Reject 'Advisory Board' Concept

Posted: June 8, 2012

www.insidehealthreform.com

Internal emails between American Medical Association lobbyists and White House aides during the health reform debate indicate that while AMA disagreed with the Senate's framework for the Independent Payment Advisory Board it did not “totally reject the concept of an advisory board.”

AMA lobbyist Richard Deem wrote on Jan. 13, 2010 to White House Office of Health Reform Director Nancy-Ann DeParle and former Deputy Chief of Staff Jim Messina that AMA was getting criticized by some of its member physicians and specialty and state medical societies for not having signed onto a coalition letter opposing the IPAB's creation, though AMA said it would be sending its own letter on the IPAB issue. The email is included in the latest round of documents released by House Energy and Commerce Republicans showing stakeholder health reform negotiations with the administration.

AMA said that while the Senate framework for IPAB was “unacceptable,” the group did not outright oppose the idea of an advisory board. In a separate document outlining its priorities for health reform that was a part of the latest GOP documentation release, AMA said enhanced authority for MedPAC should be subject to certain conditions, including that elected officials must retain authority to override its proposals. MedPAC should also not have authority for across-the-board payment cuts or sequestration and its composition should include more practicing physicians, AMA wrote.

AMA also wrote that primary care increases should not be subject to a budget neutrality requirement, and that health reform legislation should not authorize any new scope of practice expansion. The priorities, sent to DeParle, are dated May 4, 2011, though that may be a typo since it was more than a year after the Affordable Care Act was enacted.

In response to the emails' release, AMA President-elect Jeremy Lazarus told Inside Health Policy, “The AMA’s support for the health reform law reflects our role as a leading voice for covering the uninsured and was based on policy passed by our House of Delegates, which includes members from every state and virtually all medical specialty societies. Our discussions with policymakers about the need to cover the uninsured began well before work started on the health reform law, and our position during the debate was public and well-known.”

AMA emails also document the association's whip count on the Senate's permanent Sustainable Growth Rate repeal bill and senators the group was targeting to gain support, with Deem writing on Oct. 18, 2009 that they are “within striking distance of 60 [votes] but not there yet.”

Deem wrote that AMA had 41 senators confirmed or leaning “yes.” Out of 28 senators where AMA lacked specific feedback or they were undecided, the association predicted it had 13 additional “yes” votes, totaling 54 votes. A few days before, AMA and AARP had written a joint letter to Senate Majority Leader Harry Reid (D-NV) asking him to vote for consideration and passage of the Senate bill.

Undecided senators that AMA was targeting to vote for SGR repeal in the fall of 2009, according to Deem's email, included Sens. Ben Nelson (NE), Mary Landrieu (LA), Joe Lieberman (CT), Claire McCaskill (MO), Olympia Snowe (ME), Susan Collins (ME) and Mike Crapo (TX). Sens. Russ Feingold (OR), Mark Warner (VA) and Tom Carper (DE) were leaning no, and additional GOP senators in play included Sens. George Lemieux (FL), John Ensign (NV), Saxby Chambliss (GA) and Johnny Isakson (GA), according to the emails.

“Again, this is before full impact of grassroots felt, and we believe the picture will change Monday afternoon after Senate offices become more aware of AMA and AARP coalition,” Deem writes.

On Oct. 21, 2009 the Senate voted 53-47 to reject cloture on the motion to proceed to the bill. At that time, although there had been negotiations to consider Republican amendments, the legislation needed to overcome a procedural hurdle and in the end the votes weren't there. The large failure of Democrats to vote for the bill was seen as a devastating defeat for the bill's sponsor, Sen. Debbie Stabenow (D-MI), AMA and Democrats in general.

A few months later AMA communicated to Democratic leaders that it opposed a short-term payment patch of any duration, and around the same time Sen. Tom Harkin (D-IA) acknowledged that permanent SGR repeal could be a few years away.